Tackle Management Corporation

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

TACKLE MANAGEMENT CORPORATION

Practice address

8637 Mathis Ave
Manassas, VA 20110-5270

Phone

(703) 335-6890

NPI assigned

Nov 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Theresa Lynn Coates

Title

Practice Administrator

Phone

(703) 368-1800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BULL RUN FOOT CLINIC Doing business as

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Tackle Management Corporation

  • Foot & Ankle Surgery Podiatrist
  • Manassas, VA
  • NPI 1831212067
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1033399688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8637 MATHIS AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105270",
            "telephone_number": "703-335-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8637 MATHIS AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105270",
            "telephone_number": "703-335-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACKLE MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "COATES",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "703-368-1800",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "296209",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BULL RUN FOOT CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacquelyn Tang Sy, OTD
• Rossana T Sy, MD
• Syamala K. Naroji MD PC
• Syamala K. Naroji MD PC
• Syncharmony Reh & Behavioral Care LLC
• Tackle Management Corporation
• Hendeke Tafesse
• Njogho Tagyen
• Hamid Taheri, MD
• Chelsea Takyiwaah

• Foot & Ankle Surgery Podiatrist in Manassas, VA
• Providers in Manassas, VA by specialty
• Foot & Ankle Surgery Podiatrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.